Regulations gone awry -- an example from transplantation

A general lesson of market design is that participants have big strategy sets, so any given set of rules can have unanticipated undesirable consequences.  Here's an example from transplantation. Transplant centers are regulated in part based on their one-year survival rate.

Here's a story from the BMJ:

US hospital is accused of keeping vegetative patient alive to boost its transplant survival rate

"Federal agents are investigating a New Jersey hospital accused of keeping a patient with catastrophic brain damage alive for a year and barely consulting his family, in order to keep its one year transplantation survival rate from falling to a level where the programme’s Medicare certification might be withdrawn.

"The Centers for Medicare and Medicaid Services, which has its own law enforcement agency, will lead the investigation into Newark Beth Israel Medical Center. The hospital has launched its own internal probe.
...
"Newark Beth Israel’s heart transplantation programme is among the top 20 in the country by volume. A banner on the hospital’s facade says, “1000 hearts transplanted. Countless lives touched.”

"But in 2018, its one year survival rate fell significantly below the 91% national average. Young’s death would bring the average down to 81%, which staff feared would trigger sanctions from the public payer."

HT: Alex Chan